Provider Demographics
NPI:1417276916
Name:PATEL, TEJASKUMAR M
Entity Type:Individual
Prefix:
First Name:TEJASKUMAR
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TEJAS
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1269 LEITH HALL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-8200
Mailing Address - Country:US
Mailing Address - Phone:904-208-8137
Mailing Address - Fax:
Practice Address - Street 1:7546 103RD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-6713
Practice Address - Country:US
Practice Address - Phone:904-777-3050
Practice Address - Fax:904-777-6568
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist